Out-of-Area Services. 1. In areas where the Company offers contracting provider status directly or through arrangements to a class or classes of providers (such as Hospitals and/or physicians):
Out-of-Area Services. FHS shall manage and coordinate out-of-area services. PPG shall cooperate fully with FHS and shall provide any information necessary to transfer Members back into the Service Area, including but not limited to, notification to FHS of known or suspected out-of-area services. PPG shall accept the prompt transfer of Member to the care of PPG and its Participating Providers following the receipt of out-of-area services when medically appropriate.
Out-of-Area Services. Blue Cross and Blue Shield of Louisiana has a variety of relationships with other Blue Cross and/or Blue Shield Plans and their Licensed Controlled Affiliates (“Licensees”). Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross and Blue Shield Association. Whenever You obtain healthcare services outside the geographic area We serve, the Claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described below. When You receive care outside of Our service area, You will receive it from one of two kinds of Providers. Most Providers (“Participating Providers”) contract with the local Blue Cross and/or Blue Shield Licensee in that geographic area (“Host Blue”). Some Providers (“Non-Participating Providers”) do not contract with the Host Blue. We explain below how We pay both kinds of Providers. Inter-Plan Arrangements Eligibility – Claim Types All Claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all Dental Care Benefits when paid as medical Benefits, and those Prescription Drug Benefits or vision care Benefits that may be administered by a third party contracted by Us to provide the specific service or services.
Out-of-Area Services. Claim Administrator has a variety of relationships with other Blue Cross and/or Blue Shield licensees referred to generally as “Inter-Plan Arrangements.” These Inter-Plan Arrangements operate under rules and procedures issued by the Association. Whenever Covered Persons access health care services outside the geographic area Claim Administrator serves, the Claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described generally below. Claim Administrator’s services under this Agreement are governed by and subject to the Inter-Plan Arrangements rules in effect during the term of this Agreement, and a Host Blue is neither the agent nor the subcontractor of Claim Administrator. Typically, when accessing care outside the geographic area Claim Administrator serves, Covered Persons obtain care from Participating Healthcare Providers. In some instances, Covered Persons may obtain care from Non-Participating Healthcare Providers. Claim Administrator remains responsible for fulfilling its contractual obligations to Employer. Claim Administrator’s payment practices in both instances are described below. This disclosure describes how Claims are administered for Inter-Plan Arrangements and the fees that are charged in connection with the Inter-Plan Arrangements. Dental care benefits, when paid as stand-alone benefits, and prescription drug benefits or vision care benefits that may be administered by a third party contracted by Claim Administrator to provide the specific service or services, are not processed through Inter-Plan Arrangements.
Out-of-Area Services. Wellmark has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “Inter-Plan Arrangements.” These Inter-Plan Arrangements operate under rules and procedures issued by the Association. Whenever Members access health care services outside the geographic area Wellmark serves, the claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described generally below. Typically, when accessing care outside the geographic area Wellmark serves, Members obtain care from health care providers that have a contractual agreement (“participating providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, Members may obtain care from health care providers in the Host Blue geographic area that do not have a contractual agreement (“nonparticipating providers”) with the Host Blue. Wellmark remains responsible for fulfilling its contractual obligations to Account and Wellmark’s payment practices in both instances are described below. Wellmark Health Plan of Iowa, Inc. covers only limited health care services received outside of the Wellmark Health Plan of Iowa, Inc. service area. As used in this Section “Out-of-Area Covered Services” include emergency care, accidental injuries, approved guest membership, or approved out-of-network referrals obtained outside the geographic area Wellmark Health Plan of Iowa, Inc. serves. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by Wellmark Health Plan of Iowa, Inc.
Out-of-Area Services. Keystone has a variety of relationships with other BlueCross and/or BlueShield Plans and their Licensed Controlled Affiliates (“Licensees”). Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the BlueCross BlueShield Association (“Association”). Whenever Members obtain healthcare services outside of Keystone’s Approved Service Area, the claims for these services may be processed through one of these Inter-Plan Arrangements. When Members receive care outside Keystone’s Approved Service Area, Members will receive it from one of two kinds of providers. Most providers (“Participating Providers”) contract with the local BlueCross and/or BlueShield Licensee in that geographic area (“Host Blue”). Some providers (“Nonparticipating providers”) don’t contract with the Host Blue. Keystone explains below how Keystone pays both kinds of Providers. Keystone covers only limited healthcare services received outside of Keystone’s Approved Service Area. As used in this section, “Out-of-Area Covered Healthcare Services” include Emergency Care, Urgent Care and related authorized follow-up services obtained outside the geographic area of Keystone serves. Any other services will not be covered when processed through any Inter-Plan Arrangements unless authorized by a Member’s Primary Care Physician (“PCP”). Inter-Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all Dental Care Benefits, except when paid as medical claims/benefits, and those Prescription Drug Benefits or Vision Care Benefits that may be administered by a third party contracted by Keystone to provide the specific service or services.
Out-of-Area Services. Overview Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called Inter-Plan Arrangements and they work based on rules and procedures issued by the Blue Cross Blue Shield Association. Whenever you receive Covered Ser- vices outside of California, the claims for those services may be processed through one of these In- ter-Plan Arrangements described below. When you access Covered Services outside of Cal- ifornia, but within the United States, the Common- wealth of Puerto Rico, or the U. S. Virgin Islands (BlueCard® Service Area), you will receive the care from one of two kinds of providers. Partici- pating providers contract with the local Blue Cross and/or Blue Shield Licensee in that other geo- graphic area (Host Blue). Non-participating providers don’t contract with the Host Blue. Blue Shield’s payment practices for both kinds of providers are described below and in the Choice of Providers section of this EOC.
Out-of-Area Services. Overview Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called Inter-Plan Arrangements and they work based on rules and procedures issued by the Blue Cross Blue Shield Association. Whenever you receive Covered Ser- vices outside of California, the claims for those services may be processed through one of these In- ter-Plan Arrangements described below. When you access Covered Services outside of Cal- ifornia, but within the United States, the Common- wealth of Puerto Rico, or the U. S. Virgin Islands (BlueCard® Service Area), you will receive the care from one of two kinds of providers. Partici- pating providers contract with the local Blue Cross and/or Blue Shield Licensee in that other geo- graphic area (Host Blue). Non-participating providers don’t contract with the Host Blue. Blue Shield’s payment practices for both kinds of providers are described below and in the Choice of Providers section of this EOC. Blue Shield will notify the Member of its determi- nation within 30 days after receipt of the claim. To submit a claim for payment, send a copy of the itemized bill, along with a completed Blue Shield claim form to the Blue Shield address listed on the last page of this EOC. Claim forms are available online at xxx.xxxxxxxxxxxx.xxx or Members may call Blue Shield Customer Service to obtain a form. At a Inter-Plan Arrangements
Out-of-Area Services. Provider shall cooperate fully with SelectCare in SelectCare’s activities relating to management and coordination of Out-of-Area Services, including, without limitation, accepting the transfer of a Member to the care of Provider following such Member’s receipt of Out-of-Area Services. SeleetCare, after consultation with Provider and the Member’s treating physician, shall make all decisions regarding the duration of a Member’s care at a facility outside of Provider Service Area and transfer of the Member to Provider.
Out-of-Area Services. Out-of-area Emergency services are those services provided outside the Service Area of the Plan in conjunction with an Emergency. BSC-HMO shall assume costs associated with out-of-area Emergency services.
